Selection And Prognostic Evaluation Of Chemotherapy Regimens For Initial Treatment Of High-Risk Gestational Trophoblastic Neoplasia

Objective: Common treatment options for high-risk gestational trophoblastic tumor(GTN)fall into two categories,They were combined chemotherapy regimens based on 5-fluorouracil(5-FU)[5-FU,KSM or combined vincristine(VCR)] and EMA/CO[etoposide(VP16),methotrexate(MTX),KSM,cyclophosphamide(CTX)and VCR].This study investigated the efficacy and prognosis of both chemotherapy regimens as initial chemotherapy for high-risk GTN.Methods: Retrospectively collect the case data of high-risk GTN patients who were newly treated at the Cancer Hospital of China Medical University from January 2002 to December 2019 and the treatment plan was 5-FU-based and EMA/CO regimens,and compared the two clinical characteristics,curative effects,toxic and side effects,and analysis of risk factors affecting the prognosis of high-risk GTN patients.Results: 1.A total of 87 patients were enrolled,and the initial SCR rate of all patients was 75.9%(66/87),and the total SCR rate was 87.4%(76/87).The SCR rate of initial treatment,the total SCR rate,the number of treatment courses required for blood β-HCG to reduce to normal,the number of consolidation courses,and the total number of treatment courses w ere not significantly different between the 5-Fu based chemotherapy regimen and the EMA/CO regimen.2.The median follow-up time was 106 months,and the 1-year,5-year and 10-year survival rates were 93.1%,84.7% and 84.7%,respectively.3.Drug resistance rate of all patients was 17.2%(15/87),and there was no statistical difference in drug resistance rate between the two groups.However,the incidence of drug resistance in 5-Fu based regimens was 11.9%(7/59)for FAV(5-FU,KSM,VCR)and 37.5%(6/16)for FA(5-FU,KSM),and there was a statistical difference between them(P=0.016).4.There were no statistical differences between the two groups in leukopenia,hemoglobin,thrombocytopenia,alanine aminotransferase,diarrhea,oral ulcer,nausea and vomiting above grade Ⅲ and above.5.Cox regression analysis found that only clinical stage was associated with survival time(P=0.003).Conclusion: 1.Both the 5-FU-based chemotherapy regimen and the EMA/CO regimen can be used as the initial treatment regimen fo r high-risk GTN patients,and the efficacy of the two is equivalent.2.The drug resistance rate of FAV regimen was lower than that of FA regimen based on 5-FU.3.Clinical staging is an independent risk factor affecting the prognosis of high-risk GTN.